May 18, 2012
NIH Podcast Episode #0159
Balintfy: Welcome to episode 159 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode, asthma awareness, high blood pressure education and more about May being Healthy Vision Month. But first, this news update. Here’s Craig Fritz.
Fritz: In an ongoing NIH clinical trial, a paralyzed woman was able to reach for and sip from a drink on her own by using her thoughts to direct a robotic arm. The trial is evaluating the safety and feasibility of an investigational device called the Braingate Neural Interface System. This is a type of brain-computer interface intended to put robotics and other assistive technology under the brain's control. The study describes how two individuals — both paralyzed by stroke — learned to use the Braingate system to make reach-and-grasp movements with a robotic arm. The results highlight the potential for long-term use and durability of the Braingate system, part of which is implanted in the brain to capture the signals underlying intentional movement. It also describes the most complex functions to date that anyone has been able to perform using a brain-computer interface. For the woman, it was the first time since her stroke that she was able to sip a drink without help from a caregiver. Scientists note that the technology is years away from practical use and that the trial participants used the braingate system under controlled conditions in their homes with a technician present to calibrate it. The system consists of a sensor to monitor brain signals and computer software and hardware that turns these signals into digital commands for external devices. The sensor is a baby aspirin-sized square of silicon containing 100 hair-thin electrodes, which can record brain activity of small groups of brain cells. It is implanted into the part of the brain that directs movement.
New NIH research shows that inhaling a concentrated saline mist does not reduce how often infants and young children with cystic fibrosis need antibiotics for respiratory symptoms. This trial is the largest-ever study of concentrated saline therapy in infants and preschoolers. Previous findings showed that concentrated saline provided some benefits to adults and older children with cystic fibrosis. The saline mist appears to loosen the thick mucus that builds up in the lungs and may reduce the recurrent infections, known as pulmonary exacerbations, that are thought to contribute to the lung damage and respiratory failure associated with the disease. Based on these 2006 findings, the use of concentrated saline in younger children has been rising. About 1 in 5 children under 6 years old with cystic fibrosis currently use this therapy—without any clear evidence that it is effective. Researchers say the findings of this study may save families of small children with cystic fibrosis from the burdensome task of daily saline treatments. It also illustrates the importance of conducting clinical research in children because therapies that benefit adults or even teenagers do not always benefit younger children in the same way.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up, high blood pressure education, more on healthy vision and asthma awareness, that’s next on NIH Research Radio.
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Asthma Awareness Month
Balintfy: In the last episode of NIH Research Radio, we talked about how May is Healthy Vision Month. We’ll have more on that later in the episode, but now turn to another health topic for May: May is also Asthma Awareness Month. Asthma is a condition that affects more than 230 million people worldwide, including more than 25 million people in the United States. We’re talking with Dr. James Kiley. He’s the director of the Division of Lung Diseases at the National Heart, Lung and Blood Institute here at NIH. And what is asthma?
Kiley: Asthma is a chronic lung disease that in short causes the airway that’s the tubes that bring air into the lung, remove waste. The airway becomes inflamed. It becomes narrow and when that happens, it makes the muscles that surround the airway constrict. So they become very narrow and it’s difficult to get air in and out of the lung. Then the cells that are lining the airway also react to these events by creating more mucus so you have a lot of fluid that’s building up and it’s sticky and again it makes the whole problem a spiraling, worsening case of getting air in and out of the lung.
Balintfy: I’ve seen that about 17 million people need medical attention because of an asthma episode. Is an asthma episode or event what we’d call an asthma attack?
Kiley: Right, as an asthma attack where people are reacting to irritants, agents, chemicals, sprays, allergens. That’s what trips off a number of events that lead to this narrowing of airway, the inflammation, the swelling that occurs and all of the cellular events that go on into produce an airway that is very sensitive and easily collapsible and then it gets very difficult to move air in and out.
Balintfy: Another way to say that is it’s hard to breath. That sounds scary.
Kiley: It’s very scary in many ways. One is it is a life threatening event. If you can’t move air in and out of your lungs and you constrict that airway and you cannot get it open with pharmacological agents then it becomes a deadly disease, a fatal disease. We’re very, very fortunate that not very many people die from asthma and we’ve been absolutely thrilled that the mortality from asthma is going down despite the fact that more people are being diagnosed with the problem. It does seem that the management of asthma is getting the attention that it needs so we prevent a lot of the very fatal and deadly outcomes that could occur.
Balintfy: Where do we stand right now when it comes to treating, or perhaps preventing asthma, Dr. Kiley?
Kiley: Well right now, we have a lot of treatments that can be used to manage asthma, but the one thing that we can’t do is we can’t prevent the onset of asthma and we have not developed cures for asthma yet. But asthma can be controlled so that most people who have asthma can have as fewest symptoms as possible, few attacks, asthma attacks as we discussed, and can sleep through the night and live a physically active healthy life. That’s the goal of most asthma management treatment objectives and that is to take steps to control the symptoms and to minimize those symptoms so that you can live a high quality of life.
Balintfy: Is there some new research or recent developments that you think are worth emphasizing during Asthma Awareness Month?
Kiley: There are a few things that are probably noteworthy that have occurred over the last year or so.
For instance, we know right now from some studies that were published out of our asthma clinical research networks that intermittent therapy within inhaled corticosteroids, one of the mainstay treatments for patients that have a persistent asthma and particularly in young children that have mild asthma, that you can use these agents in an intermittent way than on as a regular continuous basis.
There are also other medications that are being tested to look at ways in which asthma can be controlled using a variety of different bronchodilators, long acting, short acting in combination with inhaled corticosteroids that are all leading towards, you know, maximizing control.
The other exciting thing that’s going on in the research area is the whole area of genetics and how can we use genetics as a way to look for susceptibility, look for genes that might put an individual at higher risk. How can we then target therapies based on some of the genetic background of the individual.
We’ve launched a large program to look at severe asthma. Severe asthma affects a small population in the grand scheme of asthma prevalence, but they tend to be very, very burdensome, intensive management required, and they use a lot of resources.
And we have just two other quick notes. One an ongoing clinical trial that’s giving vitamin D to a pregnant woman to see if we might be able to prevent the onset of asthma. This is the first time that a study has been supported that is taking a primary prevention approach to see if one can intervene before birth and then affect the outcome of the child based on this one agent.
Then finally, probably some of the more exciting work that’s happening right now is around the microbiome and that’s the bugs that line the airway and the GI tract and occupy much of our body with us and how does that microbiome change in response to when somebody has an asthma attack. And I think the important aspect of that is can we then learn more about how to manipulate that to improve care or to improve the response to various therapies that are currently being used.
Balintfy: Dr. Kiley, can the public get involved with asthma research?
Kiley: Yes. We have a very extensive network of clinical trials going on that are supported by the NHLBI but also other institutes at NIH that have ongoing trials and we look forward to working with the patient community very, very actively in participating in those trials both as individuals being recruited into these studies, but in other manners as well. So we hope that the asthma community, particularly the patient community and the voluntary organizations that are all trying to raise awareness and bring new medicines and approaches and treatments to patients that have asthma will take advantage of these. Because we need the help and we greatly appreciate the participation of the community in doing the research. Because it’s that research that’s going to fuel the evidence that’s going to give us improved ways to help the practicing community manage patients with asthma.
Balintfy: And when it comes to managing patients with asthma, and managing asthma itself, what would you emphasize?
Kiley: So one of the mainstays of treatment for asthma is inhaled agent, inhaled medicines whether they be inhaled bronchodilators, agents that open the airway, the short term, the quick reliever type medicines, all patients with asthma usually carry these with them. The others are inhaled corticosteroids. Those are agents that that deal with the inflammation and they’re long-term controller medicines that individuals take regularly over the course, over the life of when they have the disease. Both of them are delivered by airway route through inhaled medications. It’s important that patients take those medicines.
By and large the important message here is that you need to take the medicines on a regular basis. Even though you may feel that your asthma is controlled, you don’t have any symptoms, you’re sleeping through the night, and you stop and you just say I don’t need this anymore, I’m doing fine, then you walk into a house that has a lot of cats or something in it and you react. You’re allergic to them and then all of a sudden you have a flare-up. You know, you want to try to prevent that and the only way you can do that is to maintain the good adherence and good compliance to the medicines.
Balintfy: Thank you very much Dr. James Kiley. For more information about asthma and asthma research, visit www.nhlbi.nih.gov.
National High Blood Pressure Education Month
Balintfy: May is a month of many awareness campaigns, now we turn to another: National High Blood Pressure Education. Most of us know what blood pressure is – but do we really understand the risks associated with high blood pressure, or hypertension? Dr. Lawrence Fine, a branch chief at the NIH’s National Heart Lung and Blood Institute explains, with each beat of the heart, blood is pushed out of the heart through the arteries of the body, and that’s what creates blood pressure.
Fine: Hypertension is generally considered when the blood pressure is over 140 over 90. The upper figure… and that’s the lowest number.
Balintfy: Dr. Fine points out that about 1 out of every 3 American adults has high blood pressure.
Fine: And high blood pressure is more common in older people… about half the people may have hypertension.
Balintfy: He adds that people who are obese are also at higher risk for high blood pressure. And high blood pressure is a major contributor to common health problems.
Fine: People who have high blood pressure are at higher risk for heart attacks, for strokes, kidney disease, and some other vascular diseases.
Balintfy: But Dr. Fine reminds that high blood pressure is preventable.
Fine: Preventing the rise of blood pressure is really following good lifestyle habits.
Balintfy: These good lifestyle habits are maintaining a normal body weight, eating a diet that is not high in salt, and eating the right foods. He explains that an NIH-supported and research-based eating plan is designed specifically to help lower blood pressure; it’s called DASH, short for Dietary Approaches to Stop Hypertension.
Fine: The DASH diet advocates that you should eat a lot of fruits and vegetables, a lot of non-fat or low fat dairy products, lean meat… as effective as blood pressure medications in reducing your blood pressure.
Balintfy: Dr. Fine says these same lifestyle changes that prevent high blood pressure can also lower high blood pressure. Other lifestyle factors are exercise and avoiding more than one or two drinks of alcohol a day. Medications can also be introduced to reduce high blood pressure. But Dr. Fine warns that blood pressure has to be measured.
Fine: So one of the important things about high blood pressure is you can have high blood pressure without knowing it. People have called hypertension the silent killer…that’s why it’s important to have your blood pressure checked regularly.
Balintfy: Dr. Fine adds that the blood pressure should be checked accurately as well.
Fine: You should be sitting in a comfortable position for five minutes…and take the average of it.
Balintfy: And the cuff should fit correctly. For more information on measuring blood pressure, the risks associated with high blood pressure, and how to prevent or treat high blood pressure, visit www.nhlbi.nih.gov.
Coming up, more on healthy vision. That’s next on NIH Research Radio.
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Healthy Vision Month – part 2
Balintfy: We talked in our last episode of NIH Research Radio with Dr. Rachel Bishop about May being Healthy Vision Month. As promised, we have more about healthy vision from two more experts. Dr. Emily Chew here at the NIH, and Dr. Edwin Marshall, who is chair of the Health Disparities Task Force for the National Eye Health Education Program. And we’re talking about how eye health issues affect different people differently. For example, Dr. Chew explains that older adults can expect some vision changes as they age.
Chew: Well people notice that their arms aren’t long enough, they get really presbyopic so that’s one thing that happens to everybody. Unless you’re very shortsighted, in which case you just take your glasses off and you read very well. The other things are cataracts that come on, that’s very, very common. As the aging population grows much larger, we’re going to have a large number of people with cataracts. Other things include sort of age-related type of conditions that would come on such as glaucoma, age-related macular degeneration and if you have diabetes. Diabetes of course increases with increasing age and that too can cause some eye disease.
Balintfy: Dr. Marshall explains that African-Americans are at risk for glaucoma and eye diseases associated with diabetes.
Marshall: Diabetic retinopathy is the primary one where the retina is affected by diabetes, but cataract is another one. People who have diabetes also tend to be more susceptible to developing glaucoma so it’s extremely important that people with these diseases who are particularly at risk for those diseases have a comprehensive dilated eye exam.
Balintfy: And what is a comprehensive dilated eye exam?
Marshall: A comprehensive dilated eye exam is one where the eye care practitioner will use drops to open up what’s called the pupil, that little hole in the middle of the eye, to get a better look into the back of the eye. Many of these diseases that I mentioned, glaucoma, diabetic eye disease particularly tend to be what we call silent. That is, they do not have early warning signs or symptoms that maybe associated with the onset of those diseases. So, it’s extremely important to take a very, very good, clear look into the back of the eye for signs that a disease may in fact be there prior to the person being made aware of any particular signs or symptoms.
Balintfy: Dr. Marshall adds that the comprehensive dilated eye exam is an eye health test, not just a vision test. Dr. Chew reminds that by the time vision is affected by these diseases, there may be no way to restore the loss.
Chew: That’s correct. So there are no symptoms. If you’re diabetic and your vision could be 20/20 and you have terrible things going on in your eye that you have no idea. People with macular degeneration may have early changes that are scattered throughout the retina and you still may have good vision. So all these things and glaucoma, these are all associated with good vision, by the time you detect vision loss, it may be too late.
Balintfy: But Drs. Chew and Marshall both emphasize that people can take steps to promote eye health and prevent vision loss with certain lifestyle changes.
Marshall: The best line of defense is having that comprehensive dilated eye exam, but yes, lifestyle changes are in fact very, very important as they are with general health.
Chew: Keep and maintain a good healthy balanced diet. In particular, we talk about eating green leafy vegetables and fish once or twice a week. That seems to be associated with less certain types of disease whether it causes it or not and certainly we’ve found an association. So we also know it’s good for your heart that’s why it’s important to do those healthy things.
Marshall: Knowing your family history because people who tend to have a positive family history maybe at greater risk.
Chew: Keep and maintain a good weight so we are not overweight so that prevents things like hypertension especially if you’re a diabetic, things with hypertension increases your risk of eye diseases further.
Marshall: If we have diabetes, controlling the diabetes. If we have high blood pressure, controlling the high blood pressure and of course don’t smoke.
Chew: Smoking is an increased risk for a number of things especially macular degeneration. So smoking is not good for you in any way even for your eyes.
Balintfy: Dr. Chew adds that light may be damaging for macular degeneration and wearing sunglasses might be useful against cataracts. But she and Dr. Marshall emphasize while there are good treatments for many eye diseases, the best eye health measure is prevention.
Marshall: Vision tends to be associated with one’s ability to see clearly. One of the reasons that people should have a comprehensive eye exam is that often we will be able to see clearly, but still may have in the background a disease that’s going undetected because of the lack of signs and/or symptoms. By the time it is discovered through signs and/or symptoms, the disease has been there for a considerable period of time, has caused damage, and that damage cannot be repaired.
Balintfy: For more information on healthy vision and the importance of a comprehensive dilated eye exam, as well as risk factors associated with age, race and family history, visit www.nei.nih.gov.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, June 1 when our next edition will be available. You know there are a lot more health campaigns in May that I couldn’t fit in to this month’s editions. For more about the health campaigns that are important to you, visit www.nih.gov. If you have story suggestions for a future episode or have any questions or comments about this program, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
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